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Mediastinal actinomycosis masquerading as a mass: a case of progressive dysphagia in an immunocompromised patient
  1. Dawood Shehzad1,
  2. Dawlat Khan1,
  3. Jiannan Huang1 and
  4. Emad Abu Sitta2
  1. 1 Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
  2. 2 Infectious Disease, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
  1. Correspondence to Dr Dawood Shehzad; daud.shehzad{at}usd.edu

Abstract

Actinomycosis is a rare endogenous infection characterised by indolent progression, contiguous spreading, abscess formation and draining sinuses. Here, we present a case of Schaalia odontolytica causing a mediastinal abscess that is unique in its acuity and location. Our patient presented with worsening dysphagia, and CT of her chest revealed a new mass in the posterior mediastinum displacing the oesophagus. Oesophagram revealed mild motility disorder, but no masses or ulcers within the oesophagus. Oesophagogastroduodenoscopy with endoscopic ultrasound revealed extrinsic compression of the oesophagus. Fine-needle aspiration of the mass yielded purulent fluid, which was cultured. A single colony of S. odontolytica was isolated. Initially, medical treatment was favoured, but as she developed worsening dysphagia, the abscess was drained. She continued on long-term antibiotic therapy after drainage and had complete resolution of the abscess at 1 year.

  • Oesophagus
  • Infectious diseases
  • Radiology
  • Renal transplantation
  • Respiratory medicine

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Footnotes

  • X @HuangJiannan

  • Contributors DS and JH were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. DS, JH, DK and EAS gave final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.